Category Archives: White-coated ramblings!

Ever since my first shift at Internal Medicine rotation, I’ve accustomed myself to the fact that people die all the time; Internal Medicine wards are the terminal station for the chronically ill, and I came to believe that Death lives in there. But I have always dreaded the moment I would witness someone die. It happened today.

In an Egyptian governmental hospital, It’s always the same scenario; relatives insanely knock your door asking you to come see the patient because he had “fallen silent”. He was an 80-something man with multi-system issues, and his pulse had gone unpalpable. My heart sank. My shift had almost ended, and I was there, on my own. He was on a wheelchair. Some worker should move him to a trolly so we rush him to the ER while I start CPR, but nobody was there. There’s only one working elevator at the floor that serves doctors, patients, and their relatives, so when arrests happen, you have to run to that one elevator and knock heavily shouting “arrest!” in order to get it as fast as possible. Meanwhile, the patient was still on the wheelchair, pulseless.

He got to the ER on the wheelchair, and CPR was started only when we moved him to a bed at the arrest room. I was afraid perhaps he would die because I was too slow, but then after all, I was on my own, and I did all it took to rush him there. Things get easier at the ER, at least there are residents with more experience than a lonely house officer.

“It’s too late, let him die in peace.” The resident said after multiple cycles of resuscitation.I froze.

“Wait, there’s pulse, he came back!” Said the nurse. He did come back, and I wanted to hug him for that. I think I was the only one in the room who was very thankful. To be honest, a part of me didn’t want him to die in my shift.

Then he had gone once again, we resuscitated. He came back again, but then he had gone for good.

And there I stood, facing a dead man in a room full of people who bore no emotion for him. I don’t know why I held his hand for a moment, but I kept staring at him, a part of me hoping for another comeback, and the other part relieved it was finally over. An eerie feeling. But then, this is life, and death happens.

“Let’s just state the fact that crying kids are my least favorite creatures. Sick-screaming kids, on the other hand, are my personal imagination of an alien master plot to dominate earth.”

Okay, now it turns out sick kids are the sweetest creatures ever existed, because when it comes to women in labor, well… that’s what I believe is the core of all villainy!

You think I’m exaggerating? No sir! Try having a 12-hour shift at a room with a minimum of 6 women, each one screams her guts out, each one begs and pleads “I can’t!”, “Stop it!”, “Oh God!” or “I need an analgesic!”, and each one is being yelled at to shut the hell up! I have no idea how they manage to synchronize their screams! And you’re supposed, amid all this chaos, to think and function. You have to measure their blood pressure, pulse, and temperature every hour (by the time you’re done, the next hour has already begun), you have to obtain blood samples, insert cannulae in these demons, and you have to watch how every uterine contraction is transmitted into a complex facial expression of severe agony!

And then comes the “PUSH” phase. Oh, did I mention how giving birth is painfully disgusting??

It’s been a month, and I’ve taken shifts almost everyday. My circadian rhythm is doomed for good, and my caffeine dependence has turned into addiction. So can’t we just accept that women in white gowns are devils in disguise?!

You can be an ***hole, and you can be an Ob/Gyn resident, but I repeat myself!

Well, everybody hates Ob/Gyn rounds. It’s not just the heavy work and floods of patients, it’s also just about everything else you can imagine. I’ve been only 2 weeks through and I’ve never been so miserable!

For starters, you have like 20 twelve-hour shifts per month. Although ERs are closed until further notice (nobody knows why, probably for political reasons), the lack of patients’ flow doesn’t exempt you from being there. You just have to show up everyday to do some lame tasks and bear with all the crap and nonsense your residents come up with. You’re not allowed to leave until the last minute of your shift, why? Because residents say so! You have to put up with their vulgarity and rudeness, because there is no other way.

The only achievement I can count is crossing “scrub in” off my bucket list. Yet, surprisingly, I haven’t found any thrill in surgeries; it’s too boring! I have to say I haven’t learnt a thing so far, and I dread the moment I go home because it means tomorrow’s coming and I’ll have to go back again. Yes, I’m that miserable!

Undeniably, we have a defective system, no I’m kidding, we have no system at all! If you’ve ever been to a hospital, you already know that a major part of a nurse’s job is giving injections, obtaining blood samples, blood transfusion, IV salines, inserting cannulae, and monitoring the patients vitals (blood pressure, temperature, etc.).

Since the very first day as a house officer, I’ve been doing all of the above, and because there’s no such thing as porters, I’m also the one sent with patients’ files and blood samples to finish the paperwork. I haven’t done a single task that required any of the medical knowledge I earned in the past 7 years. I no longer even know what nurses are for, I mean beside mastering the art of humiliating and delaying you!

Example: A patient is so feverish and needs an immediate IV antipyretic. I am the one responsible, so I go to the nurse and beg for the medication. She refuses, and demands the patient’s file first, which should’ve been with her in the first place. I don’t have the file, so I call the resident, and she tells me I should find it with the nurse. And the vicious cycle goes on until I find the file on the nurse’s desk! Meanwhile, the patient remains feverish!

While you try your best to get the above mentioned tasks attained, residents (who mostly have narcissistic issues) can do whatever it takes to abort them. I have to admit that my residents so far are kind enough to teach me and thank me for my efforts, but I get sent daily to other departments to request consultations and interventions, and I almost always get shooed like a cockroach or treated like I didn’t exist. It’s so pathetic that some residents are so delusional they believe they are the Gods of their specialty!

Example: A 3-month-old boy needs a urinary catheter. The pediatric resident doesn’t want to catheterize him, so she sends me to surgery hospital looking for a urinary tract resident. I request the procedure, but the resident ignores me as if I’m a mosquito buzzing around his head. When he finally responds, he tells me to wait. I wait for an hour, but he never shows up!

The only reason I put up with this crap, is because I once believed I could help make patients’ quality of life better, which right now sounds very naïve and ridiculous! Now one only gotta do this for the sake of God and nothing else!

First off, let’s just state the fact that crying kids are my least favorite creatures. Sick-screaming kids, on the other hand, are my personal imagination of an alien master plot to dominate earth.

So basically, my 12 hours at pediatric ER were witnessing vomiting, diarrhea, pneumonias, and the non-ceasing chorus of screeches mingled with the beeping of monitors. Such scenario would be somehow tolerable if it wasn’t in a governmental third-world hospital. Remember when I said it’s kind of like Grey’s Anatomy, except that it’s nothing like it?

Well, for starters, we deal with the lowest possible socioeconomic classes. Most of the patients are impecunious and ignorant (if not even illiterate), that never annoyed me; it’s not their fault and they deserve treatment. The disaster is that we, doctors, have to function with the least infection control measures (if not without any). The floor is dirty, and there are stray cats and cockroaches! I have seen a doctor collecting a blood sample without wearing gloves, the baby’s blood trickling all over her fingers, and when she was done and saw the shock on my face, she told me “don’t do what I just did!” There is a box of gloves sitting on the nurses desk, but few doctors care enough to use any. That sickens me!

Another emotionally devastating thing was how the bed sheets were blood-drenched, urine-stained, and needle-studded! I have been to governmental hospitals in UAE and seen how the sheets were disposable and consistently replaced. What I saw yesterday was just so wrong!

Back to kids, in such an overwhelmingly stressful situation, I tried not to get involved. How could I manage patients I have no sympathy for? The kids seemed like noisy things who needed to shut up! The only kid I sympathized with was 4-year-old who needed calcium gloconate injections to treat his hypocalcimic condition. He looked so harmless and terrified, he persistently begged to go home and I found myself trying so hard to sooth and lull him to stop him from moving his hand and displacing his cannula. I have no idea how that boy managed to break my heart!

And there I survived my first night shift ever! I’m not looking forward to my next one!

So today was my first day as an intern doctor. Let me tell you something about hospital internships in Egypt, you know, it’s kind of like Grey’s Anatomy, except that it’s nothing like Grey’s Anatomy! I’ll be thoroughly talking about this, but not today. Stay posted!

What happened today was a cycle of pleading and begging. Why? Because Egyptian “public servants” are heartless and always bad-tempered. Originally, I was listed in one of the ministry’s hospitals, but I filed a request to be moved to my med school’s educational hospital (not today’s story), let’s just focus on the fact that I DID hand the request to the woman in the corresponding office.

Consequently, I should’ve found my name automatically listed in the hospital’s schedules, which hasn’t happened! You don’t want to know the details, because it’s so boring, but to cut the story short, they lost my request, and I had to spin around and get shooed from one office to another to file a new one, begging the employees to just answer my Goddamned questions!

On the plus side, I finally have been listed in pediatrics with cool friends. But we have a night shift tomorrow! Yep, my first ER shift ever is tomorrow! Stay tuned!